Resuscitative Endovascular Balloon Occlusion of the Aorta is Associated with Increased Risk of Extremity Compartment Syndrome

Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a temporizing procedure to control intra-abdominal or pelvic bleeding. Theoretically, occlusion of the aorta and the resulting ischemia–reperfusion of the lower extremities may increase the risk of extremit...

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Bibliographic Details
Published in:World journal of surgery 2023-03, Vol.47 (3), p.796-802
Main Authors: Wu, Yu-Tung, Lewis, Meghan R., Arase, Miharu, Demetriades, Demetrios
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adult
Aorta
Aorta - surgery
Balloon Occlusion - adverse effects
Balloon Occlusion - methods
Balloon treatment
Cardiac Surgery
Cardiovascular system
Comorbidity
Compartment syndrome
Compartment Syndromes
Complications
Coronary vessels
Endovascular Procedures - adverse effects
Endovascular Procedures - methods
Extremities
Fractures
Fractures, Bone
General Surgery
Humans
Injuries
Injury Severity Score
Ischemia
Lower Extremity
Medicine
Medicine & Public Health
Occlusion
Original Scientific Report
Pelvis
Prophylaxis
Quality control
Reperfusion
Resuscitation - methods
Retrospective Studies
Risk analysis
Risk factors
Shock, Hemorrhagic - therapy
Subgroups
Surgery
Thoracic Surgery
Thromboembolism
Trauma
Vascular Surgery
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Summary:Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a temporizing procedure to control intra-abdominal or pelvic bleeding. Theoretically, occlusion of the aorta and the resulting ischemia–reperfusion of the lower extremities may increase the risk of extremity compartment syndrome (CS). To date, no study has addressed systematically the incidence and risk factors of CS following REBOA intervention. The purpose of this study was to address this knowledge gap. Methods Adult trauma patients from the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database (2016–2019) were included. Patients who received REBOA within 4 h of admission were compared to patients without REBOA after propensity score matching for demographics, vital signs on admission, comorbidities, injury severity of different body regions, pelvic and lower extremity fractures, vascular trauma to the lower extremities, fixation for fractures, angioembolization (AE) for pelvis, preperitoneal pelvic packing (PPP), laparotomy, and venous thromboembolism (VTE) prophylaxis. The primary outcomes were rates of lower extremity CS and fasciotomy and acute kidney injury (AKI). Secondary outcomes included mortality. Results There were 534 patients who received REBOA matched with 1043 patients without REBOA. Overall, patients in the REBOA group had significantly higher rates of CS than no REBOA patients [5.4% vs 1.1%, p  
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-022-06832-2